Continuity of Care Changes

20 de octubre de 2021

Requirement of the Consolidated Appropriations Act (plan years on or after Jan. 1, 2022)

Most of our group and fully insured plans currently include a time period for continuity of care at in-network reimbursement rates when a provider leaves our networks. La nueva legislación también exige la continuidad de la atención para los asegurados afectados cuando:

  • Se producen cambios en el estado de la red de un profesional médico
  • Una cobertura de seguro médico grupal cambia de emisor de seguro de gastos médicos, lo que lleva a que el asegurado ya no tenga acceso a un proveedor participante de nuestra red.

What this means for you
If you leave our network, we will notify members and allow them to request continuity of care for the following conditions or care:

  • Tratamiento de un problema médico grave y complejo
  • Atención médica institucional o para pacientes hospitalizados
  • Schedule a nonelective surgery
  • Embarazo o tratamiento por embarazo
  • Enfermedad terminal

Members can choose to continue services with the same in-network coverage for either (the earlier date):

  • 90 days after the notice
  • The date they’re no longer a continuing care patient

State laws, which may require a longer continuity of care period for certain conditions, will continue to apply.

You (or your facility) must accept payment from us plus member cost share as payment in full during the continuity of care period.

More on the CAA and Transparency in Coverage Final Rule.